Update: Radiography in Spinal epidural metastases

Most of the spinal epidural metastases are osteolytic, but at least 50 % of the bone must be eroded before plain x ray abnormality 1).

Not very specific.
see Winking owl sign
Plain x-rays are quite good at evaluating bony metastases, but not good at evaluating the spinal cord and surrounding soft tissues. Metastatic epidural spinal cord compression most commonly occurs at the site of vertebral involvement on plain x-ray, especially where there is evidence of vertebral collapse. Most common findings on x-rays include pedicle erosion, paravertebral soft shadow, vertebral collapse, and pathologic fracture or dislocation 2).
In the past, if there was back pain or a localizing sign and spinal x-ray was abnormal, the probability of epidural disease was 0.9, but if the x-ray was normal, the probability was only 0.1 3) 4).
In 1990, x-rays were found to have a 10% to 17% false negative rate 5).
The rate of missed metastatic epidural spinal cord compression is unacceptable.
1) Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors. Semin Neurol. 2004 Dec;24(4):375-83. Review. PubMed PMID: 15637649.
2) Perrin RG. Metastatic tumors of the axial spine. Curr Opin Oncol 1992;4(3):525-32.
3) Rodichok LD, Harper GR, Ruckdeschel JC, et al. Early diagnosis of spinal epidural metastases. Am J Med 1981;70(6):1181-8.
4) Portenoy RK, Galer BS, Salamon O, et al. Identification of epidural neoplasms. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine. Cancer 1989;64(11):2207-13.
5) Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien). 1990;107(1-2):37-43. PubMed PMID: 2096606.

Color Atlas of Neurology

Color Atlas of Neurology
By Reinhard Rohkamm

Color Atlas of Neurology (Clinical Sciences (Thieme))
Price: $32.53
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Highly Commended at the 2004 British Medical Awards Medical Book Competition!
Neurology – made visible
Every practitioner in modern medicine is confronted daily with neurologic symptoms, diagnoses, and clinical problems. Yet there is scarcely any other medical specialty that is so fraught with complexities and abstractions. This pocket atlas is designed to provide a better, easier-to-understand visual guide on what the reader needs to know about neurology. In a unique way, neurology is made visible in the truest sense of the word.
Coverage includes:

  • The basic principles of neuroanatomy and neurophysiology (structure of the CNS, peripheral nerves, stimulus transmission, nerve conduction velocity, etc.)
  • Diagnostic methods and procedures (clinical examinations, electrophysiologic techniques, imaging studies, etc.).
  • Neurologic disorders including their clinical manifestations, pathogenesis, and principles of treatment.

These topics and more are covered in elaborately drawn, meticulously labeled illustrations. The effective concept of placing the illustrations opposite the descriptive text for a particular subject has created word-and-picture units that combine maximum teaching impact with an optimum density of information. Neurologic relationships can be grasped literally at a glance. This pocket atlas is intended for medical students, physicians, and other medical professionals (nurses, physical therapists, occupational therapists, speech therapists) who could profit from a visual guide to neurology.


Product Details

  • Published on: 2003-12-10
  • Original language: English
  • Number of items: 1
  • Dimensions: .80″ h x 5.50″ w x 7.60″ l, 1.10 pounds
  • Binding: Paperback
  • 440 pages

Editorial Reviews

Review

Easily readable, with subheadings, informative summaries and key references, which allow rapid orientation in the comprehensive subject matter. Logical and easy-to-understand text is placed opposite beautifully drawn and labeled illustrations, thus enhancing the book’s didactic utility. This small atlas is a precious and unique visual guide to neurology’s most difficult concepts, a book that should always be close at hand. It is a ‘must have’ for all who are interested and engaged in the open and inspiring field of clinical neuroscience and practice. –Acta Clinica Croatica

From the Back Cover

Highly Commended at the 2004 British Medical Awards Medical Book Competition!
Neurology – made visible
Every practitioner in modern medicine is confronted daily with neurologic symptoms, diagnoses, and clinical problems. Yet there is scarcely any other medical specialty that is so fraught with complexities and abstractions. This pocket atlas is designed to provide a better, easier-to-understand visual guide on what the reader needs to know about neurology. In a unique way, neurology is made visible in the truest sense of the word.
Coverage includes:

  • The basic principles of neuroanatomy and neurophysiology (structure of the CNS, peripheral nerves, stimulus transmission, nerve conduction velocity, etc.)
  • Diagnostic methods and procedures (clinical examinations, electrophysiologic techniques, imaging studies, etc.).
  • Neurologic disorders including their clinical manifestations, pathogenesis, and principles of treatment.

These topics and more are covered in elaborately drawn, meticulously labeled illustrations. The effective concept of placing the illustrations opposite the descriptive text for a particular subject has created word-and-picture units that combine maximum teaching impact with an optimum density of information. Neurologic relationships can be grasped literally at a glance. This pocket atlas is intended for medical students, physicians, and other medical professionals (nurses, physical therapists, occupational therapists, speech therapists) who could profit from a visual guide to neurology.

About the Author

Director, Neurological Clinic, Friesland Hospital, Sande, Germany


Color Atlas of Neurology, Second Edition is a well-organized and illustrated text with anatomic and physiological information pertinent to physicians, advanced practice providers, medical students, and nursing students. While nonboard certified neurologists will be the greatest beneficiaries of the information in this book, board-certified neurologists and neurosurgeons can focus on a number of pages of this book for reminders of pertinent information that will help them treat their patients.

The text is divided into 4 sections. It starts with fundamentals that explain basic central and peripheral nervous system anatomy. For learners, neuroanatomy and its clinical relevance are elusive concepts; Rokhamm’s text facilitates acquisition of information in digestible portions that do not require hours of reading and synthesizing of plain text. Novice learners will benefit from explanations and illustrations of the nervous system. The illustrations allow the reader to visualize both physiology and pathophysiology. For the more experienced provider, this section is a good reference to review when questioning a finding on physical exam, trying to better understand a certain condition, or determining if an abnormal finding is peripheral or central in origin.

The text then explores functional system pathways more deeply. This second section provides a review of pain, memory, autonomics, and other functional pathways. Normal physiological findings are described, and explanations of why the findings are normal are included. Illustrations clearly show the origin and termination of pathways that generate normal physical findings, such as muscle stretch reflexes. The undergraduate, medical student, and advanced practice provider learners will likely spend extensive time in this section, as the functional pathways covered are essential to practicing good neurology.

The third section focuses on abnormal findings, syndromes, and the effect of disease on target organs and systems. The authors explain the pathophysiology of abnormal findings and where they are occurring within neurological pathways. Relevant physical finding illustrations are reminiscent but distinct from Netter’s work, picturesquely describing the major points. In particular, we enjoyed the pages devoted to describing gait and its associated disorders.

The fourth and final section is the most extensive section of the book, as the authors synthesize information skillfully, again using in-text illustrations to provide complete explanations of the manifestations of neurology disease processes that are inclusive of neuroanatomy and pathophysiology. Numerous diseases are reviewed, and it is the most useful section for active providers and more experienced practitioners. Diseases that are particularly well described are various types of stroke and spinal cord injury.

In conclusion, Color Atlas of Neurology, Second Edition, by Reinhard Rohkamm, is an excellent text for providers at every level. Its organization, illustrations, and depth make it a text that we would recommend to students, residents, and colleagues alike. This is not a text that will gather dust on a shelf; its place is in the pockets of white coats of learners who are on rotations, or on the desk of nurse practitioners who care for patients with neurological diseases, non-neurologists who encounter patients with neurological disease, and neurologists and neurosurgeons who require a quick reminder for specific questions related to their patients.

Update: Spinal arachnoid cyst

Spinal arachnoid cyst

Epidemiology

Almost always dorsal, most common in the thoracic spine.
Most are extradural and these are sometimes referred to as arachnoid diverticula – these may be associated with kyphoscoliosis in juveniles or with spinal dysraphism.

Etiology

Intradural arachnoid cysts may be congenital or may follow infection or trauma.

Clinical features

Usually asymptomatic, even if large.

Differential diagnosis

Vith a ventral cyst, consider a neurenteric cyst.

Treatment

When indicated, treatment options include:
1. percutaneous procedures: may be done under MRI 1). or CT guidance. CT guidance usually requires use of intrathecal contrast to delineate the cyst
A. needle aspiration.
B. needle fenestration.
2. open surgical resection or fenestration

Case report

Takahashi et al. describe the case of a high cervical, intradural extramedullary cyst located anterior to the spinal cord in a 13-year-old boy. The lesion was fenestrated percutaneously by using real-time magnetic resonance (MR) imaging guidance and a local anesthetic agent. The patient’s symptom, severe exercise-induced headache, immediately resolved after treatment. Nine months later, complete disappearance of the cyst was confirmed on MR imaging and computerized tomography myelography. Magnetic resonance imageing-guided fenestration can be considered a minimally invasive option for intradural cystic lesions 2).
1) , 2) Takahashi S, Morikawa S, Egawa M, Saruhashi Y, Matsusue Y. Magnetic resonance imaging-guided percutaneous fenestration of a cervical intradural cyst. Case report. J Neurosurg. 2003 Oct;99(3 Suppl):313-5. PubMed PMID: 14563151.
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